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A scoping review of inequities in access to organ transplant in the United States.

Publication ,  Journal Article
Park, C; Jones, M-M; Kaplan, S; Koller, FL; Wilder, JM; Boulware, LE; McElroy, LM
Published in: International journal for equity in health
February 2022

Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research.We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes.Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant.This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity.

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Published In

International journal for equity in health

DOI

EISSN

1475-9276

ISSN

1475-9276

Publication Date

February 2022

Volume

21

Issue

1

Start / End Page

22

Related Subject Headings

  • Waiting Lists
  • United States
  • Tissue and Organ Procurement
  • Public Health
  • Prospective Studies
  • Organ Transplantation
  • Humans
  • Healthcare Disparities
  • Health Services Accessibility
  • Female
 

Citation

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ICMJE
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Park, C., Jones, M.-M., Kaplan, S., Koller, F. L., Wilder, J. M., Boulware, L. E., & McElroy, L. M. (2022). A scoping review of inequities in access to organ transplant in the United States. International Journal for Equity in Health, 21(1), 22. https://doi.org/10.1186/s12939-021-01616-x
Park, Christine, Mandisa-Maia Jones, Samantha Kaplan, Felicitas L. Koller, Julius M. Wilder, L Ebony Boulware, and Lisa M. McElroy. “A scoping review of inequities in access to organ transplant in the United States.International Journal for Equity in Health 21, no. 1 (February 2022): 22. https://doi.org/10.1186/s12939-021-01616-x.
Park C, Jones M-M, Kaplan S, Koller FL, Wilder JM, Boulware LE, et al. A scoping review of inequities in access to organ transplant in the United States. International journal for equity in health. 2022 Feb;21(1):22.
Park, Christine, et al. “A scoping review of inequities in access to organ transplant in the United States.International Journal for Equity in Health, vol. 21, no. 1, Feb. 2022, p. 22. Epmc, doi:10.1186/s12939-021-01616-x.
Park C, Jones M-M, Kaplan S, Koller FL, Wilder JM, Boulware LE, McElroy LM. A scoping review of inequities in access to organ transplant in the United States. International journal for equity in health. 2022 Feb;21(1):22.
Journal cover image

Published In

International journal for equity in health

DOI

EISSN

1475-9276

ISSN

1475-9276

Publication Date

February 2022

Volume

21

Issue

1

Start / End Page

22

Related Subject Headings

  • Waiting Lists
  • United States
  • Tissue and Organ Procurement
  • Public Health
  • Prospective Studies
  • Organ Transplantation
  • Humans
  • Healthcare Disparities
  • Health Services Accessibility
  • Female